Gardasil (human papillomavirus vaccine), the vaccine that can prevent most cases of cervical cancer in girls, has won the FDA’s blessing as a vaccine to prevent anal cancer, a huge victory for men!

The FDA’s  approval for Gardasil as an anal cancer vaccine opens the way for the medication’s maker, Merck and Co. Inc., to market the vaccine to boys and young men between the ages of nine and 26 – an option that will be most meaningful for men who have sex with men, but valuable to all.  Nobody likes getting HPV on their penis.  It really can devastate many boys and men.  When the HPV ends up on their anal area – the risk of anal cancer is high.  Although this is most commonly seen in homosexual men, it is not infrequent for heterosexual men to be at risk.  It is easy to imagine how HPV can start on the shaft, and with a scratch here, and an itch there – end up on the back side.

This is a great win for men – and we hope that the approval by the FDA will quickly translate to coverage amongst insurance companies to make the vaccine accessible quickly to this new population.

What are anal warts?

Anal warts (also called “condyloma acuminata”) are a condition that affects the area around and inside the anus. They may also affect the skin of the genital area. They first appear as tiny spots or growths, perhaps as small as the head of a pin, and may grow larger than the size of a pea. Usually, they do not cause pain or discomfort to afflicted individuals. As a result, patients may be unaware that the warts are present. Some patients will experience symptoms such as itching, bleeding, mucus discharge and/or a feeling of a lump or mass in the anal area.

Anal warts, thought to be caused by the human papilloma virus, can grow larger and spread if not removed.

It is important to know that Anal warts can be found both heterosexuals and in men who have sex with men.  Either way, it is nothing to be ashamed of – and it is something that you SHOULD SEEK TREATMENT FOR.

What causes these warts?

They are thought to be caused by the human papilloma virus (HPV) which is transmitted from person to person by direct contact. HPV is considered a sexually transmitted disease. You do not have to have anal intercourse to develop anal condyloma.

Do these warts always need to be removed?

Yes. If they are not removed, the warts usually grow larger and multiply. If left untreated, the warts may lead to an increased risk of cancer in the affected area.  This is similar to the risks of cervical cancer in women.

What treatments are available?

If warts are very small and are located only on the skin around the anus, they may be treated with a topical medication. They may also be treated by a physician by freezing the warts with liquid nitrogen. Warts may also be removed surgically. Surgery provides immediate results but must be performed using either a local anesthetic – such as novocaine – or a general or spinal anesthetic, depending on the number and exact location of warts being treated. Warts inside the anal canal usually are not suitable for treatment by medications, and in most cases need to be treated surgically.

Must I be hospitalized for surgical treatment?

No. Surgical treatment of anal warts is usually performed as outpatient surgery.

How much time will I lose from work after surgical treatment?

Most people are moderately uncomfortable for a few days after treatment, and pain medication may be prescribed. Depending on the extent of the disease, most people return to work the next day.

How long is treatment usually continued?

Follow-up visits are necessary at frequent intervals for several months after the last wart is observed to be certain that no new warts occur.

What can be done to avoid getting these warts again?

In some cases, warts may recur repeatedly after successful removal, since the virus that causes the warts often persists in a dormant state in body tissues. Discuss with you physician how often you should be evaluated for recurrent warts. Abstain from sexual contact with individuals who have anal (or genital) warts. Since many individuals may be unaware that they suffer from this condition, sexual abstinence, condom protection or limiting sexual contact to single partner will reduce your potential exposure to the contagious virus that causes these warts. As a precaution, sexual partners ought to be checked, even if they have no symptoms.

as a urologist i see a lot of patient with growths or bumps on the penis

some patients ask do I have cancer? do I need a biopsy? 

Most patients with a classic wart or HPV do not need a biopsy, patient who are uncircumcised or recurrent growths may consider a biopsy.

Freezing a wart with liquid nitrogen, cauterization, or topical treatments like aldara (imiquimod topical cream)

if you have a wart get to a doctor and have it treated.  A biopsy is not a  bad idea but no always necessary

thanks for all of stories and questions I hope this site can help you fight your personal war on warts. 

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In a study published in The New England Journal of Medicine, gay and bisexual men were found to have a significantly higher risk for developing anal cancer, over thirty-five times greater than the general population. HIV-positive men were estimated to be eighty times more likely to get it. Although anal cancer accounts for less than 5 percent of all digestive and intestinal tract cancers, the rates have increased 160 percent over a thirty- year period. Gay African-American men have the sharpest increase and the lowest survival rates. Interestingly, anal cancer in gay men is as common as cervical cancer was in women before the use of the Pap smear, the test that screens for precancerous lesions on the cervix. Both types of cancer are caused by the human papillomavirus (HPV), which also causes anal and genital warts. HPV is one of the most common STDs in the world. Fortunately, anal cancer is highly preventable and treatable if caught in time.

There are more then one hundred different subtypes of HPV, and some are the source of common warts as seen on the hands and feet. HPV affects approximately 65 percent of HIV-negative gay men, and nearly 95 percent of HIV-positive gay men carry HPV in their anal canals. Most do not even know they have it. Subtypes 6 and 11 cause 90 percent of genital warts, while subtypes 16 and 18 are far more dangerous because of their precancerous potential.

The lining of the anal canal, once infected with HPV, can reproduce uncontrollably if left untreated. In most cases, the immune system clears the infection naturally, but in a small number of cases, usually over many years, HPV can cause changes in the cells of the anus and rectum that can lead to cancer. The Pap smear is something that should be offered to all gay men. In March 2007, the New York State Department of Health AIDS Institute, in collaboration with the Johns Hopkins Division of Infectious Diseases, issued the following recommendation concerning anal Pap smear.

Clinicians should perform anal Pap tests at baseline and annually in the following populations:

1. Men who have sex with men

2. Any patient with a history of anal or genital warts

Clinicians should refer patients with abnormal anal Pap test findings for high- resolution anoscopy and/or examination with biopsy. Like cervical cancer, invasive squamous cell cancers of the anal canal are associated with certain types of HPV infection, most notably, HPV-16 and HPV- 18. Although this is a new practice that may not be routinely available, screening for cellular dysplasia is recommended, particularly in persons at high risk for infection with papilloma viruses.

There are various ways to treat genital and anal warts depending on the size and location. Topical medications, like podofilox & Imiquimod (Aldara) can sometimes be used.  Cryotherapy, electrodesiccation, application of trichloroacetic acid or bichloroacetic acid and interferon injections are just some of the many treatment options that should be discussed with your physician.

The anal Pap smear is a simple test that is performed by your doctor in his office. It involves swabbing the anus with a Dacron swab, which looks like a long Q-Tip. The swab is then smeared on slides and sent to the pathologist. This test is so important because there are many different types of HPV. The most common are types 6, 11, 16, and 18. Certain subtypes, specifically 16 and 18, are considered precancerous. As a patient, you should report any cauliflower-like lesions that develop on your skin because HPV can show up on your penis, anus, and even your tongue.

In 2006, Merck & Co delivered the first vaccine for HPV called Gardasil. It is a quadrivalent vaccine, which means it works on HPV subtypes 6, 11, 16, and 18, and it is given in three separate injections over six months. Currently, the vaccine is indicated only for women, but the majority of gay health- care providers are urging their gay male patients to consider this vaccine, especially those men who are HIV positive or have a history of HPV. At this time the vaccine is not covered by insurance and would have to be paid for out of pocket. Presently, Merck is studying this vaccine in 4,000 young men, including those who engage in sex with other men, and the National Institutes of Health (NIH) is evaluating the response to Merck’s vaccine in preteen HIV- positive boys and girls.

adapted from source: http://www.advocate.com/health/healthstory_ektid61607.asp?Category=Health+%26+Treatments

Anal warts are caused by the human papilloma virus, which is usually transmitted through sexual contact but not necessarily through anal intercourse. The same type of warts may occur on the penis, scrotum, vagina or labia. It is important to recognize and treat anal warts if you have them, as the risk of developing cancer is high.  The time from exposure to the virus and growth of the warts is commonly from one to six months, but it can be longer. During that time the virus remains in the tissues but is inactive. There are many types of human papilloma virus; some cause warts on the hands and feet and others cause genital and anal warts.